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Impaired coronary flow reserve is associated with increased echocardiographic epicardial fat thickness in metabolic syndrome patients

Tok, Derya; Çağli, Kumral; Kadife, Iskender; Turak, Osman; Özcan, Firat; Başar, Fatma N.; Gölbaşi, Zehra; Aydoğdu, Sinan

doi: 10.1097/MCA.0b013e32835d75d1
Pathophysiology and Natural History

Objectives Metabolic syndrome (MetS) is a strong predictor of cardiovascular events and coronary flow reserve (CFR), an indicator of microvascular function, has been found to be impaired in MetS. Epicardial fat thickness (EFT) reflects visceral adiposity and is considered an important cardiometabolic marker. In this study, we aimed to examine the presence of an association between CFR and EFT in MetS patients.

Methods Forty-six MetS patients (25 men, mean age 47.3±6.6 years) and 44 age-matched and sex-matched controls (24 men, mean age 46.0±6.1 years) were prospectively studied. Both CFR and EFT were measured by transthoracic echocardiography. Peak diastolic coronary flow velocities were measured in the left anterior descending artery by pulsed wave Doppler at the baseline and after adenosine infusion, and CFR was calculated as the ratio of hyperemic to baseline velocities.

Results The waist circumference, total and low-density lipoprotein-cholesterol, fasting glucose, triglycerides, systolic and diastolic blood pressures, and high sensitive C-reactive protein were significantly higher in MetS patients. The mean EFT was significantly higher in MetS patients compared with the controls (8.7±0.2 vs. 4.8±0.1 mm, P<0.001); however, CFR was significantly lower in MetS patients (2.3±0.2 vs. 2.7±0.2, P<0.001). CFR was correlated significantly with BMI, waist circumference, high-density lipoprotein-cholesterol, triglycerides, fasting glucose, high sensitive C-reactive protein, and EFT. In regression analysis, MetS itself and EFT were found to be independent predictors of impaired CFR.

Conclusion CFR is impaired in MetS patients. MetS itself and increased EFT are associated independently with coronary microvascular dysfunction and EFT is a predictor of worse CFR even after accounting for the presence or absence of the MetS.

Department of Cardiology, Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey

Correspondence to Derya Tok, MD, Department of Cardiology, Yuksek Ihtisas Education and Research Hospital, Sihhiye, 06100 Ankara, Turkey Tel: +90 312 3061000 x1822; fax:+90 312 3124120; e-mail:

Received August 7, 2012

Accepted December 2, 2012

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins